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Before Abby Bales had surgery for ulcerative colitis, she couldn’t make it through the day without a nap. But Bales was more than just tired — she was experiencing fatigue, a common symptom of ulcerative colitis that drains energy and causes an overwhelming sense of exhaustion.

“When I was flaring, and for the last year before surgery, the fatigue was absolutely unreal,” says Bales, a doctor of physical therapy in New York City and author of the blog Run Stronger Every Day. “I required a nap in the middle of the day just to make it to the end of the day.”

Like Bales, nearly 75 percent of people with an inflammatory bowel disease (IBD) such as ulcerative colitis experience fatigue when their condition is flaring, according to a study published in 2011 in the journal Inflammatory Bowel Diseases. What’s more, 30 percent of the people in this study who were in remission — meaning that they weren’t experiencing other symptoms of ulcerative colitis — also qualified as having fatigue.

“Fatigue is not a universal symptom of ulcerative colitis, but it’s a common one,” says William Katkov, MD, a gastroenterologist at Providence Saint John's Health Center in Santa Monica, California. “The important point is that fatigue should be addressed by both the patient and the treating physician.”

If you’re living with ulcerative colitis and you're experiencing fatigue, it may feel as if you’ll never get your energy back. But by tightening control of your condition and making some healthy lifestyle changes, you can manage your fatigue. Start here.

What Fatigue Feels Like

Fatigue is beyond just a passing feeling of being tired, explains Dr. Katkov. “People with ulcerative colitis can experience malaise, a profound kind of fatigue that makes it difficult to carry out normal activities.”

Tina Haupert, who was diagnosed with ulcerative colitis in 2011, agrees. “I'm pretty much always tired,” she says. “But I do my best to eat well and exercise, which seems to help.”

One of the most frustrating aspects of ulcerative colitis fatigue is its unpredictable nature. From 2010 to 2014, the British organization Crohn’s and Colitis UK assessed more than 500 people with IBDs to learn more about their fatigue. Many participants complained that it would come on suddenly, without warning, and vary from day to day. They also said that this type of fatigue — which they described with the terms “brain fog,” “completely wiped out,” and “zombie mode” — had a negative effect on their quality of life. It affected their memory and concentration, made it harder for them to exercise or attend social activities, and interfered with their relationships and ability to work. And it often took a hefty emotional toll, lowering their confidence or leading to depression.

Ensuring that fatigue doesn’t interfere with the quality of life, the ability to work, and the capacity to have a normal social life is central to the goal of treating a chronic condition like ulcerative colitis, Katkov notes. “We don’t want to settle for a lower quality of life than what can be achieved with aggressive treatment,” he says.

What Causes Ulcerative Colitis Fatigue?

While people with ulcerative colitis may experience fatigue for a number of reasons, it may simply be caused by the body’s response to inflammation in the colon, says Katkov.

In addition, fatigue is sometimes related to anemia, which is a common complication of ulcerative colitis, caused by blood loss, diarrhea, and malabsorption of nutrients. Other possible triggers include certain medications, inadequate sleep, being overweight or underweight, and pain, according to the findings of the Crohn’s and Colitis UK study.

And don’t rule out the emotions. “With any patient — but especially someone with a chronic disease,” Katkov says, “you want to consider their emotional life, stress, and depression.”

9 Tips for Managing Your Fatigue

The key to easing fatigue is not to ignore it. “Fatigue is a sign that something requires attention,” Katkov says. Consider the following steps.

Get ulcerative colitis under control with treatment. Since fatigue is often related to the symptoms and inflammation of ulcerative colitis, it’s more prevalent when the disease is active. “When ulcerative colitis is well controlled, a patient is not expected to have fatigue,” Katkov says. Work with your doctor to find the best treatment approach for your condition.

Rule out other causes of fatigue. “Go through the full list of diagnostic possibilities,” Katkov says. For example, if your ulcerative colitis is in remission and you’re still experiencing fatigue, have your healthcare provider run a blood test to check for anemia or vitamin deficiencies. Or ask your doctor whether a medication or a recent stressful situation might be triggering your tiredness. Says Katkov, “Get to the root of the problem and address it.”

Move more. It may seem counterintuitive, but exercise has been shown to have a positive effect on fatigue in people with ulcerative colitis, according to a 2014 review of research in BioMed Research International. Haupert, who’s a self-proclaimed fitness “nut” and the author of the blog Carrots 'N' Cake, suggests that you try to do something active every day — “even if it's a short walk around your neighborhood. Even though I battle fatigue, I always feel better and more energized after some exercise.”

Try to sleep eight hours a night. “A growing body of evidence suggests that disordered or inadequate sleep can significantly impact health,” says Katkov. “And fatigue is central to that.” As a rule of thumb, the National Sleep Foundation recommends that adults get seven to nine hours of sleep each night. If tossing and turning at night is leaving you feeling fatigued the next day, talk to your doctor about ways to improve your sleep. Also, consider cutting back on caffeine and removing distracting electronic gadgets from your bedroom.

Eat your vitamins. There’s no cure-all diet for ulcerative colitis or fatigue, but eating well certainly plays a role in overall health, says Katkov, who suggests that you educate yourself about a healthy, balanced diet that's rich in a range of vitamins.

Plan ahead. Got a big event on the calendar? “Make sure you have time to rest before and after,” Bales says. “Stress and lack of sleep don't do anything good for your immune system.”

Rethink the 9-to-5 day. “When fatigue is significant, adjustments in work are appropriate and recommended,” Katkov says. If fatigue is hindering your ability to get through the workday, consider asking your employer whether he or she would allow you to work more flexible hours.

Try to reduce stress. Practice relaxation techniques (for example, yoga, tai chi, and deep breathing), and you may find the benefits to be twofold. According to a review of research in Gastroenterology Research and Practice, easing your level of tension may lower your risk of an ulcerative colitis flare — and reducing stress may also help lessen fatigue.

Learn your fatigue triggers. Everyone’s different, so try to figure out which habits wear you out and which tend to put a little pep in your step — and act on them accordingly. “Manage your life in a way that works for you,” Bales recommends. “If that means you work out in the morning and go to bed early in the evening, that's the way you need to do it.”